NORTRIPTYLINE - Johns Hopkins Hospital

NORTRIPTYLINE

Nortriptyline is FDA approved for treatment of symptoms of depression. It is also a useful treatment for chronic neuropathic pain. Your prescription will be given in generic form, so that the cost will be less than that of the brand name.

The medicine comes in 25, 50, and 100 mg tablets. The maximum dose is 150 mg per day but lower doses help may people.

Initially, you will take one 25 mg tablet at bedtime. Although this is a small dose, in many people low doses (25-75 mg at bedtime) are enough to control the symptoms of pain. You should take a single tablet (25 mg) each night for 1 week, one hour before bedtime, before increasing the dose. If, at this low dose, there is no change in your pain, then you should increase by one tablet at bedtime, so that you will now be taking 50 mg at bedtime. If this dose does not help in relieving you pain, then you can increase again. Increases in dosage can be made safely every 1 week without contacting your physician. However, if you reach 100 mg at bedtime, further increases in the dose should be discussed with your physician. At that point, your physician may elect to change your tablets to a larger strength or add doses in the morning.

If you find a dosage level that is satisfactory, there is no reason to increase the medication. If, after you have increased the medication, you find that the previous -- that is, lower--dose was just as effective, it would be wiser to use the lesser dose.

DOSING SCHEDULE FOR NORTRIPTYLIBE 25 MG TABLETS

Start After 1 week After 1 week After 1 week

Insert Date

Morning None None None None

Evening

Daily Dose

1 tablet 25 mg

2 tablets 50 mg

3 tablets 75 mg

4 tablets 100 mg

Notes Call Doctor

The medication has several side-effects.

Dry mouth occurs in almost everybody when the dose is greater than 75 mg at night. There is no harm in this side-effect but it will be a good gauge of your continuing compliance with the medicine.

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Drowsiness may occur just as you increase from one dose to another, but it usually subsides after your body gets used to the medicine over several days. This is why dosage increases should be done no quicker than every 7 days.

Some people find nortriptyline "activates" them, making sleep difficult. If that happens, please switch to taking the tablets in the morning.

Other less common side-effects include cloudy thinking, urinary retention, irregular heart beat, and light-headedness upon arising.

No blood monitoring is needed while taking Nortriptyline.

NORTRIPTYLINE (By mouth) Nortriptyline (nor-TRIP-ti-leen)

Treats depression. Also used to treat various types of pain. This medicine is a tricyclic antidepressant.

Brand Name(s):Pamelor There may be other brand names for this medicine.

When This Medicine Should Not Be Used: You should not use this medicine if you have had an allergic reaction to nortriptyline or other tricyclic antidepressants (such as Elavil?, Sinequan?, or Tofranil?), maprotiline (Ludiomil?), or trazodone (Desyrel?). You should not use this medicine if you have used a monoamine oxidase (MAO) inhibitor (such as Nardil?, Marplan?, Parnate?) within the past 14 days. You should also not use this medicine if you have just had a heart attack.

How to Use This Medicine: Capsule, Liquid

? Your doctor will tell you how much medicine to use and how often. ? May be taken with or without food. ? This medicine should come with a Medication Guide. Read and follow these instructions

carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.

If a dose is missed:

? If more than one dose a day is used, use the missed dose as soon as possible unless it is

almost time for your next dose.

? You should not use two doses at the same time. ? If only one dose at bedtime is used, you should not use the missed dose in the morning.

How to Store and Dispose of This Medicine:

? Store at room temperature, away from excess heat, light, and moisture. Do not freeze the oral

liquid.

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? Keep all medicine out of the reach of children.

Drugs and Foods to Avoid: Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

? Make sure your doctor knows if you are using Tagamet?, Antabuse?, or thyroid medicine. ? Do not drink alcohol with this medicine. ? Make sure your doctor knows if you are using other medicines that make you sleepy such as

sleeping pills, cold or allergy medicine, sedatives, tranquilizers, or narcotic pain killers.

Warnings While Using This Medicine:

? Talk to your doctor before using if you are pregnant or breastfeeding, or if you have a history of

heart disease, glaucoma, epilepsy, or stomach problems.

? For some children and teenagers, this medicine can increase thoughts of suicide. All of the

warnings in this leaflet are true for a child or teenager who is using this medicine. Tell your doctor right away if you start to feel more depressed. Also tell your doctor right away if you have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Make sure your caregiver knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell your doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let your doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

? If you are using this medicine for depression, it may take 2 or 3 weeks of treatment before you

start to feel better.

? Nortriptyline may increase or decrease blood sugar levels. ? Do not stop using nortriptyline suddenly. You may need to use smaller and smaller doses

before completely stopping. Check with your doctor.

? This medicine may cause drowsiness, especially during the first few weeks you are using it. Be

careful when driving a car or operating machinery.

? The oral solution (liquid) has alcohol in it.

Possible Side Effects While Using This Medicine: Call your doctor right away if you notice any of these side effects:

? Severe confusion ? Hallucinations ? Hives, or swelling of face, lips, or tongue ? Trouble going to the bathroom (urinating) ? Unexplained or sore throat

If you notice these less serious side effects, talk with your doctor:

? Drowsiness or dizziness ? Constipation ? Dry mouth ? Nausea ? Blurred vision ? Sensitivity to sunlight

If you notice other side effects that you think are caused by this medicine, tell your doctor.

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